CSP 511

Ethical Dilemma
Case
Anais Rocha, Giselle Rivera-Quiroz, Vanessa Van
Scan here for our handout ☺
 The Case
You are working with a student who shares with you that
she is cutting and shows you the marks on her arm. They
are very faint lines and do not appear to have broken
the skin. Further, she tells you that her parents are aware
of the scars on her arms and therefore there is no
reason for you to call the home. She asks if she can
continue to see you for counseling.
 Questions to Consider

How do you Who would Do you break

respond? you consult confidentiality
with at your and call
site? parents?
 The student is physically harming
themselves, even though it has not broken
the skin.

The The student is (possibly) using cutting as a

means of coping with something.

Problem The student is not currently seeing a

therapist, but is asking for long-term
Defined emotionally counseling.
and intellectually
The student's parents know, yet the student
continues to cut themselves.
 ASCA Code of Ethics
A.1.E
Provide culturally responsive counseling in a brief context & support students &
families/guardians in obtaining outside services if students need long
term...counseling.

A.2.G A.2.H A.9.A

Primary obligation is to student for
confidentiality, w/...parents/guardians
legal + inherent rights to be the
guiding voice in their child's lives.
Balance students' choices w/ legal
rights & responsibilities.
Collaborate with and involve students
to the extent possible and use the
most appropriate and least intrusive
method to breach confidentiality if
such action is warranted.
Inform parents/guardians & school
administration when a student poses
a serious + foreseeable risk of harm
to self or others...even if danger
appears relatively remote, parents
guardians must be notified.

ASCA, 2022
 ACA Code of Ethics
A.2.B
Counselors explicitly explain the nature of all services provided. They inform
clients about issues such as...limitations, potential risks...clients have a right to
confidentiality...

B.2.A B.7.A F.9.C

The general requirement that
counselors keep things confidential
does not apply when disclosure is
required to protect or identify others
from serious and foreseeable harm...
Information shared in a consulting Counseling for students if students
relationship is discussed for request counseling...counselor
professional purposes only. educators assist in identifying
appropriate services.

ACA, 2014
 The Law
Assembly Bill 2246
This bill requires all California school districts to adopt a
suicide prevention, intervention, and follow-up plan for
grades 7-12
What This Means
Every district is going to have their own policy for
handling situations involving suicide and self-harm, so it
is always best to consult with a trusted colleague before CA Legislative
taking action. Information,
2016
 Chronological
The student's age is not disclosed.

Chronological Based on the information provided, one

could assume the student is in middle
school-high school as cutting is most
& often found in pre-teens and teens
(kidshealth.org).
Developmental Developmental
Levels The student is seeking help on their own.

The student is speaking up about their

mental health concerns to a trusted adult.
Consider the setting, parental rights, and minor's

rights
Setting: School

The student will be notified that

Minor's rights:
counselors will speak with their

parents, and she is welcome to attend

the meeting.

They have the right to know that their

Parental rights: child is self-harming because it

concerns the child's safety.

 Apply the moral principles
Autonomy:
Help her realize why she self-harming. In addition, help find healthy coping mechanisms. Help her learn why

self-harming can negatively impact her. Bottom line it would be her decision if she wants to stop or not.

Validate her feelings and telling her that what she is feeling is okay. We as school counselors are there

Beneficence: for her and are willing to help her. We are willing to work with her to implement any interventions at

Tier 2 and 3 to prevent any occurrence of similar situations in the future,

Letting the client know that we are only contacting her parents because it is our legal obligation and

Npnmaleficence: it’s for her safety. In addition, we are only sharing information about self-harming and any

additional information is only said if the client is comfortable with it.

Listen to our client without any judgement and providing any resources that they client may need. In

Justice: addition, refer her to outside resources such as therapists for long term counseling services.

Honor out commitment to providing best standard of care to our clients. In addition, providing the

Loyalty: necessary resources to our clients that best fit their needs. Providing a welcoming environment to all

students.

(Miller & Davis, 2016)

 Ask to our client about why is self-harming

happening. Discuss with her about our legal

obligations therefore, we will be contacting her

Determine the potential

parents about the situation, even though her

courses of action and

parents may already know about the marks.

Fortunately, we will be only discussing about the

their consequences self-harm and any additional information will only

be said if the client is comfortable with it. We will

tell her that she is welcoming to attend the meeting.

Determine the potential

Connecting our client to our school

courses of action and

psychologists and outside professional for
their consequences additional help.
Determine the potential
Having interventions that is within our

courses of action and

their consequences
MTSS model. For this specific case, we will

conducting Tier 2 or Tier 3 intervention

for our client.

Determine the potential
Contiune to check up out client to see

how she's doing but will not be

courses of action and

their consequences
conducting long term counseling with

her. Continue to have a welcoming and

supportive environment for her.

 Our Course of Action
Tell the student you are a mandated reporter, and her description of
self-harm is sufficient means for breaking confidentiality. Reassure
the student is not in trouble, but parents will be notified due to
safety concerns. Ask the student if she would like to be present when
parents are informed. Inform the student she is welcome to check in
with you, but recommend them an outside mental health professional
for long-term counseling. Then, while the student is supervised by
another counselor, consult with another counselor to confirm a
suicide assessment as the next step (tier 3). Discuss suicide assessment
with the school psychologist and parents to urge them to monitor their
child. Discuss what is pertinent to the parent’s knowledge of the
counseling session, and provide them with a list of resources for
outside mental health professional help for evaluation and treatment
of suicide ideation if necessary.
Evaluate the Selected Course of Action

We cannot take the student's word that her parents know. We have to break
confidentiality, regardless if there's no broken skin.
they could be telling you what they think you want to hear
Identify her current emotional distress, support system, and provide potential
alternatives/coping skills to self-harm (safety plan).
include instrument of use to remove them from the student’s sight or access

Standard of care: Consulting with competent school personnel to support

student & discuss self-harm intervention/preventions for tier 1 & 2 levels
do not leave student unattended when consulting
 Consult
Another competent school counselor

Administrator

School Psychologist

School Social Worker

Mental Health community agency (if available)

 1 Screen for suicide

2 Notify parents, school admin, school psychologist

Implement 3
Provide references to outside mental health
professionals/orgs to both parents and student

the Course 4
Identify & develop self-harm prevention/intervention
programs if not present already

of Action
5 Self-care for staff following a self-harm incident
 Resources
Crisis Hotline GoGuardian
 References
American School Counselor Association (ASCA). (n.d.). Www.schoolcounselor.org.

https://www.schoolcounselor.org/Magazines/July-August-2018/Asked-and-Answered
Responding to self-harm, including suicide attempts, in students. (n.d.).

https://www.education.vic.gov.au/PAL/responding-to-self-harm-including-suicide-attempts-in-students-a-

guide-to-assist-secondary-schools.pdf
Self-injury: An overview for counselors. (2020, September 16). Counseling Today.

https://ct.counseling.org/2020/09/self-injury-an-overview-for-counselors/
Forester-Miller, H., & Davis, T. E. (2016). Practitioner’s guide to ethical decision making (Rev. ed.). Retrieved

from http://www.counseling.org/docs/default-source/ethics/practioner’s-guide-toethical-decision-

making.pdf
https://www.crisistextline.org/topics/self-harm/#what-is-self-harm-1
https://www.goguardian.com/suicide-self-harm-resources
Thank You!